what independent nursing interventions would a nurse implement after
assessing that a client is experiencing a hypoglycemic episode?

The human body draws on glucose ( the sugar circulating in your
bloodstream ) for energy. When glucose levels fall below normal, the
body cannot meet its energy requirements. The symptoms and
complications of hypoglycemia develop as your system tries to extract
energy from body fat and muscle. It is not a disease but a condition
that results from low blood sugar levels caused when:

1. the body's glucose is used up too rapidly;
2. when glucose is released into the bloodstream more slowly than is
needed by your body or:
3. when excessive insulin is released into the bloodstream. (to
convert glucose into energy, the body relies on the pancreatic hormone
insulin)

Hypoglycemia is relatively common in diabetics and occurs when too
much insulin or oral anti-diabetic medication is taken, not enough
food is eaten, or from a sudden increase in the amount of exercise
without an increase in food intake.

Treatment really depends on the severity of the attack. If the person
is conscious and able to respond, a snack or drink containing sugar
will raise the blood-glucose level and should result in an immediate
improvement in symptoms.

Infants of diabetic mothers that develop low blood sugars are treated
with glucose solutions given into the vein to maintain the blood sugar
at normal levels. The glucose is slowly reduced over the next 24 to 48
hours while the infant begins to regulate its blood sugar at normal
levels.

But if a person's blood-sugar levels are so low that he/she becomes
unconsciousness or is unable to swallow, emergency medical treatment
is needed. This condition is called insulin shock. Insulin is a
hormone produced by the pancreas in response to increased glucose
levels in the blood, which then reduces blood glucose. Immediate
treatment often includes the injection of a concentrated dose of
glucose directly into the blood. In other cases, an injection of the
hormone glucagon may be required, administer with caution given a
patient with a history of cardiovascular or renal disease. Other
possible contraindications include known hypersensitivity to the drug,
pregnancy or the presence of an adrenal gland tumour.

Glucagon is produced by the pancreas and causes the liver to release
its stored sugar into the bloodstream. A shot increases a person's
blood sugar level at least 30 milligrams per deciliter (mg/dL) in
about five minutes. A person who is having a low blood sugar emergency
can safely have more than one glucagon shot but the shots should be
given and the patients levels monitored by someone who knows how to
give them correctly. Afterwards, the person who has received a
glucagon shot  needs to eat or drink at least 15 grams of carbohydrate
and have some type of protein. Side effects are rare but glucagon can
cause hypotension, dizziness, headache, nausea, and vomiting.

Severe cases of hypoglycemia may require hospitalization, and the
person may be given additional glucose intravenously for an extended
period (possibly days), until blood sugar levels are stable in the
normal range. For prolonged severe hypoglycemia, additional treatment
may be necessary if brain swelling (edema) or damage has occurred or
if there are other complications.

Because hypoglycemic episodes can impair a person's mental
functioning, it is important other members of a household should also
learn to recognize the symptoms of low blood sugar. In situations
where there is a risk of severe hypoglycemia, other members of the
household should learn about emergency care for low blood sugar.
People at risk of developing moderate or severe hypoglycemia should
wear a medic-alert badge or bracelet in case an episode occurs when
they are away from family, friendsor caregivers who are aware of their
condition.

Sources/References

MEDLINEplus Health Information: Medical Encyclopedia – Hypoglycemia
http://www.nlm.nih.gov/medlineplus/ency/article/000386.htm

WebMD Health: Encyclopedia – Hypoglycemia
http://my.webmd.com/encyclopedia/article/1667.53924

Wisconsin Department of Health: SAMPLE APPROVED PROTOCOLS – EMERGENCY
MEDICAL TREATMENT OF HYPOGLYCEMIA WITH GLUCOSE MONITORING AND
ADMINISTRATION OF GLUCAGON
://www.google.ca/search?q=cache:VQn0qfItPmkC:www.dhfs.state.wi.us/DPH_EMSIP/EMS/Protocols/Glucagon_adm.pdf+hypoglycemia+%22medical+treatment%22&hl=en&ie=UTF-8


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the question was specifically about independent nursing interventions,
and the answer provided steps that mostly would not be able to be
carried out independently by a nurse, unless the hospital or other
setting had in place very specific protocols for nursing staff. Such
protocols exist in some places, but may or may not include such things
as glucose infusions. And response would depend on a variety of
circumstances: does the patient have an IV in place, is she a known
diabetic, etc. Absent specific protocols allowing specific
interventions, the nurse should rapidly gather data: level of
consciousness, vital signs, info about medications and time of
delivery, volume status (I and O), and get hold of the physician ASAP.
Giving oral sugar-containing solution of some sort would nearly always
be allowed prior to physician contact, unless the patient had
contraindications such as post op status, bowel obstruction, etc.